Healthcare Provider Details

I. General information

NPI: 1912219957
Provider Name (Legal Business Name): LALITHAMBAL VENUGOPALAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD
PALO ALTO CA
94304-1507
US

IV. Provider business mailing address

750 WELCH RD
PALO ALTO CA
94304-1507
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA110810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: